Provider Demographics
NPI:1790093151
Name:PADHIAR, AMI K (RPH)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:K
Last Name:PADHIAR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3525
Mailing Address - Country:US
Mailing Address - Phone:732-599-3075
Mailing Address - Fax:732-599-3075
Practice Address - Street 1:315 N SHILOH RD # 102-B
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6620
Practice Address - Country:US
Practice Address - Phone:459-929-6627
Practice Address - Fax:469-929-6632
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02699000183500000X
TX39248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist